Women’s Reproductive Health: Ovarian cancer
Gynaecologic cancer is any cancer that starts in a woman’s reproductive organs. Cancer is always named for the part of the body where it starts. Gynaecologic cancers begin in different places within a woman’s pelvis, which is the area below the stomach and in between the hip bones.
Types of Gynaecologic Cancer
- Cervical cancer begins in the cervix, which is the lower, narrow end of the uterus. (The uterus is also called the womb.)
- Ovarian cancer begins in the ovaries, which are located on each side of the uterus.
- Uterine cancer begins in the uterus, the pear-shaped organ in a woman’s pelvis where the baby grows when she is pregnant.
- Vaginal cancer begins in the vagina, which is the hollow, tube-like channel between the bottom of the uterus and the outside of the body.
- Vulvar cancer begins in the vulva, the outer part of the female genital organs.
Today, we will discuss about Ovarian Cancer.
Ovarian cancer is when abnormal cells in the ovary begin to multiply out of control and form a tumour. If left untreated, the tumour can spread to other parts of the body. This is called metastatic ovarian cancer.
The ovaries are two female reproductive glands that produce ova, or eggs. They also produce the female hormones oestrogen and progesterone.
More than 22,000 women in the United States will receive an ovarian cancer diagnosis in 2017, and 14,000 women will die from it.
Ovarian cancer often has warning signs, but the earliest symptoms are vague and easy to dismiss. Twenty percent of ovarian cancers are detected at an early stage.
What are the early symptoms of ovarian cancer?
It’s easy to overlook the early symptoms of ovarian cancer because they’re similar to other common illnesses or they tend to come and go. The early symptoms include:
- abdominal bloating, pressure, and pain
- abnormal fullness after eating
- difficulty eating
- an increase in urination
- an increased urge to urinate
Other symptoms:
- fatigue
- indigestion
- heartburn
- constipation
- back pain
- menstrual irregularities
- painful intercourse
- dermatomyositis (a rare inflammatory disease that can cause skin rash, muscle weakness, and inflamed muscles)
These symptoms may occur for any number of reasons. They aren’t necessarily due to ovarian cancer. Many women have some of these problems at one time or another. These types of symptoms are often temporary and respond to simple treatments in most cases.
Again, cancers are best treated when detected early. Please consult with your doctor if you experience new and unusual symptoms.
The symptoms will persist if they’re due to ovarian cancer. Symptoms usually become more severe as the tumour grows. By this time, the cancer has usually spread outside of the ovaries, making it much harder to treat effectively.
Contact your doctor if you have one or more of these symptoms for a significant period.
Types of Ovarian Cancer
The ovaries are made up of three types of cells. Each cell can develop into a different type of tumour:
- Epithelial tumours form in the layer of tissue on the outside of the ovaries. About 90 percent of ovarian cancers are epithelial tumours.
- Stromal tumours grow in the hormone-producing cells. Seven percent of ovarian cancers are stromal tumours.
- Germ cell tumours develop in the egg-producing cells. Germ cell tumours are rare.
Ovarian cysts
Most ovarian cysts aren’t cancerous. These are called benign cysts. However, a very small number can be cancerous.
An ovarian cyst is a collection of fluid or air that develops in or around the ovary. Most ovarian cysts form as a normal part of ovulation, which is when the ovary releases an egg. They usually only cause mild symptoms, like bloating, and go away without treatment.
Cysts are more of a concern if you aren’t ovulating. Women stop ovulating after menopause. If an ovarian cyst forms after menopause, your doctor may want to do more tests to find out the cause of the cyst, especially if it’s large or doesn’t go away within a few months.
If the cyst doesn’t go away, your doctor may recommend surgery to remove it just in case. Your doctor can’t determine if it’s cancerous until they remove it surgically.
Risk factors for ovarian cancer
The exact cause of ovarian cancer is unknown. These factors can increase your risk:
- a family history of ovarian cancer
- genetic mutations of genes associated with ovarian cancer, such as BRCA1 or BRCA2
- a personal history of breast, uterine, or colon cancer
- obesity
- the use of certain fertility drugs or hormone therapies
- no history of pregnancy
- endometriosis
Older age is another risk factor. Most cases of ovarian cancer develop after menopause.
It’s possible to have ovarian cancer without having any of these risk factors. Likewise, having any of these risk factors doesn’t necessarily mean you’ll get ovarian cancer.
How is ovarian cancer diagnosed?
It’s much easier to treat ovarian cancer when your doctor diagnoses it in the early stages. However, it’s not easy to detect.
Your ovaries are situated deep within the abdominal cavity, so you’re unlikely to feel a tumour. There’s no routine diagnostic screening available for ovarian cancer. That’s why it’s so important for you to report unusual or persistent symptoms to your doctor.
If your doctor is concerned that you have ovarian cancer, they’ll likely recommend a pelvic exam. Performing a pelvic exam can help your doctor discover irregularities, but small ovarian tumours are very difficult to feel.
As the tumour grows, it presses against the bladder and rectum. Your doctor may be able to detect irregularities during a rectovaginal pelvic examination.
Your doctor may also do the following tests:
Transvaginal ultrasound (TVUS): This is a type of imaging test that uses sound waves to detect tumours in the reproductive organs, including the ovaries. However, TVUS can’t help your doctor determine whether tumours are cancerous.
Abdominal and pelvic CT scan: If you’re allergic to dye, they may order a pelvic MRI scan.
Blood test to measure cancer antigen 125 (CA-125) levels: This is a biomarker that is used to assess treatment response for ovarian cancer and other reproductive organ cancers. However, menstruation, uterine fibroids, and uterine cancer can also affect levels of CA-125 in the blood.
Biopsy: This involves removing a small sample of tissue from the ovary and analysing the sample under a microscope. A biopsy is the only way your doctor can confirm whether you have ovarian cancer.
What are the stages of ovarian cancer?
Your doctor determines the stage based on how far the cancer has spread. There are four stages, and each stage has sub-stages:
Stage 1
Stage 1 ovarian cancer has three sub-stages:
Stage 1A: The cancer is limited, or localized, to one ovary.
Stage 1B: The cancer is in both ovaries.
Stage 1C: There are also cancer cells on the outside of the ovary.
Stage 2
In stage 2, the tumour has spread to other pelvic structures. It has two sub-stages:
Stage 2A: The cancer has spread to the uterus or fallopian tubes.
Stage 2B: The cancer spread to the bladder or rectum.
Stage 3
Stage 3 ovarian cancer has three sub-stages:
Stage 3A: The cancer has spread beyond the pelvis to the lining of the abdomen and the lymph nodes in the abdomen.
Stage 3B: The cancer cells are outside of the spleen or liver.
Stage 3C: Deposits of cancer at least 3/4 of an inch are seen on the abdomen or outside the spleen or liver. However, the cancer isn’t inside the spleen or liver.
Stage 4
In stage 4, the tumour has metastasized, or spread, beyond the pelvis, abdomen, and lymph nodes to the liver or lungs. There are two sub-stages in stage 4:
In stage 4A, the cancerous cells are in the fluid around the lungs.
In stage 4B, the most advanced stage, the cells have reached the inside of the spleen or liver or even other distant organs like the skin or brain.
How ovarian cancer is treated?
The treatment depends on how far the cancer has spread. A team of doctors will determine a treatment plan depending on your situation. It will most likely include two or more of the following:
- chemotherapy
- radiation
- surgery to stage the cancer and remove the tumour
- targeted therapy
- hormone therapy
- Surgery
- Surgery is the main treatment for ovarian cancer.
The goal of surgery is to remove the tumour, but a hysterectomy, or complete removal of the uterus, is often necessary. Your doctor may also recommend removing both ovaries and fallopian tubes, nearby lymph nodes, and other pelvic tissue.
Identifying all tumour locations is difficult. In one study, researchers investigated ways to enhance the surgical process so that it’s easier to remove all of the cancerous tissue.
Targeted therapy
Targeted therapies, such as chemotherapy and radiation treatments, attack the cancer cells while doing little damage to normal cells in the body.
Newer targeted therapies to treat advanced epithelial ovarian cancer include bevacizumab (Avastin) and Olaparib (Lynparza). Doctors only use Olaparib in people with mutations in the BRCA genes.
Fertility preservation
Cancer treatments, including chemotherapy, radiation, and surgery, can damage your reproductive organs, making it difficult to become pregnant.
If you want to become pregnant in the future, talk to your doctor before starting treatment. They can discuss your options for possibly preserving your fertility. Possible fertility preservation options include:
Embryo freezing: This involves freezing a fertilized egg.
Oocyte freezing: This procedure involves freezing an unfertilized egg.
Surgery to preserve fertility: In some cases, surgery that only removes one ovary and keeps the healthy ovary can be done. This is usually only possible in early stage ovarian cancer.
Ovarian tissue preservation: This involves removing and freezing ovarian tissue for future use.
Ovarian suppression: This involves taking hormones to suppress ovarian function temporarily.
Ovarian cancer research and studies
New treatments for ovarian cancer are studied each year. Researchers are also exploring new ways to treat platinum-resistant ovarian cancer. When platinum resistance occurs, standard first-line chemotherapy drugs like carboplatin and cisplatin are ineffective.
Certain drugs are also studied for their potential benefits in ovarian cancer. A 2014 study examined targeted treatments for those with more advanced stages of this cancer.
Ovarian cancer treatment primarily focuses on surgery to remove the ovaries and uterus, and chemotherapy. As a result, some women will experience menopause symptoms.
A 2016 study examined how hormone therapy (HT) affects quality of life after ovarian cancer treatment.
This study found that HT is safe for menopause treatments in women with ovarian cancer. People in the study maintained a high quality of life while receiving HT after being treated for ovarian cancer.
A 2015 article looked at intraperitoneal (IP) chemotherapy. This study found that those who received IP therapy had a median survival rate of 61.8 months. This was an improvement as compared to 51.4 months for those who received standard chemotherapy.
Can ovarian cancer be prevented?
There are no proven ways to totally eliminate your risk of developing ovarian cancer. However, there are steps you can take to lower your risk. Factors that have been shown to lower your risk of developing ovarian cancer include:
- taking oral birth control pills
- breastfeeding
- pregnancy
- surgical procedures on your reproductive organs (like a tubal ligation or hysterectomy)
The outlook depends on a variety of factors, including the stage of the cancer at diagnosis, your overall health, and how well you respond to treatment. Every cancer is unique, but the stage of the cancer is the most important indicator of outlook.
Cancer of the ovary is not common, but it causes more deaths than other female reproductive cancers. The sooner ovarian cancer is found and treated, the better your chance for recovery.
